New Formulae for Calculating Left Heart Pressure in Pulmonary Artery Hypertension Patients at the Bedside
DOI:
https://doi.org/10.14205/2310-9394.2015.03.01.3Keywords:
Empirical physiological formulae, left heart pressures, haemodynamics, pulmonary artery hypertension.Abstract
Objective: To compare new empirical formulae in HeartSmart, to calculate the mean pulmonary artery and mean pulmonary artery occlusion (wedge) pressures to that of the Pulmonary Artery Catheter Thermodilution Method.
Method: 20 adult patients with pulmonary artery hypertension admitted on to Bradford Royal Infirmary NHS Trust Hospital UK Intensive Care Unit, where haemodynamic monitoring is routinely performed as part of the treatment using the thermodilution method compared to the HeartSmart to guide interventional fluid resuscitation etc. Each subject has six paired values of each left heart pressure and cardiac indexes to test the robustness of HeartSmart against the perceived "gold standard" thermodilution method. This was a double blind study the haemodynamic variables of each technology were close enough to each other.
Results: Bland-Altman plot comparing the measured mean pulmonary artery pressure (MPAP) mmHg to the Heartsmart calculated pulmonary artery pressures (CPAP) mmHg: For mean of the differences between MPAP mmHg and CPAP mmHg = - 1.08 mmHg, Legend 1.
Comparing the measured mean pulmonary artery occlusion (wedge) pressure (MPWP) mmHg to the HeartSmart calculated pulmonary artery occlusion (wedge) pressure (CPWP) mmHg: For mean of the differences between MPWP mmHg and CPWP mmHg = - 0.56 mmHg, Legend 2.
Comparing the measured mean cardiac index in litres/min/m2 MCI to the HeartSmart calculated mean cardiac index in litres/min/m2 CCI: For mean of the differences between MCI litres/min/m2 and CCI litres/min/m2 = -0.03 litres/min/m2; Legend 5.
Conclusion: The results demonstrate HeartSmartTM software compares favourably with the Pulmonary Artery Catheter thermodilution method at the bedside and could be used interchangeably or replace PACTD.
Background: The incidence of pulmonary artery hypetension is on the increase in the United Kingdom. Primary pulmonary arterial hypertension is a rare disease that is characterized by increased pulmonary-artery pressure in the absence of common secondary causes of pulmonary hypertension, such as viruses auto immune system, chronic heart, lung, or thromboembolic disease. Before the advent of new and some novel therapies, patients with idiopathic or familial pulmonary arterial hypertension average survival rates were less than 7 years. Despite the progress in diagnostic techniques and treatment, pulmonary arterial hypertension is becoming more common although remaining a progressive, debilitating fatal disease. The clinical signs and symptoms can be nonspecific, patients often receive a diagnosis too late as the condition advances, deteriorates and of course treatment is less effective.
The use of the (PAC) right heart floatation pulmonary artery catheter (Swan-Ganz) to measure the mean pulmonary artery and mean pulmonary artery occlusion (capillary wedge) pressures is one means of confirming the diagnosis of pulmonary artery hypertension, although its use is not appropriate in neonates or paediatric cases.
References
Bland JM and Altman DG. Measuring agreement in method comparison studies. Statistical Methods in Medical Research 1999; 8: 135-60. http://dx.doi.org/10.1191/096228099673819272
Critchley LA and Critchley JA. A meta-analysis of studies using bias and precision statistics to compare cardiac output measurement techniques. Journal Of Clinical Monitoring And Computing 1999; 15: 85-91. http://dx.doi.org/10.1023/A:1009982611386
Rich S. Ed. Executive summary from the World Symposium on Primary Pulmonary Hypertension 1998, Evian, France, September 6–10, 1998, cosponsored by the World Health Organization. Retrieved April 14, 2000, from the World Wide Web: http://www.who.int/ncd/cvd/pph.html.
Berridge JC, Warring-Davies K, Bland JM and Quinn AC. A new, minimally invasive technique for measuring cardiac index: Clinical comparison of continuous cardiac dynamic monitoring and pulmonary artery catheter methods. Anaesthesia 2009; 64(9): 961-967. http://dx.doi.org/10.1111/j.1365-2044.2009.05943.x
Drummond GB, Soni N and Palazzo MG. Prediction and theory in cardiac output estimates. Anaesthesia 2010; 65: 751-3. http://dx.doi.org/10.1111/j.1365-2044.2010.06394.x
Pandit JJ. Graphical presentation of data in non-invasive algorithms for cardiac output estimation. Anaesthesia 2010; 65: 310-1. http://dx.doi.org/10.1111/j.1365-2044.2010.06256_1.x
Berridge JC, Warring-Davies KJ and Bland JM. Reply: Graphical presentation of data in non-invasive algorithms for cardiac output estimation. Anaesthesia 2010; 65: 310-1. http://dx.doi.org/10.1111/j.1365-2044.2010.06256_1.x
Fabbroni D and Quinn A. A retrospective evaluation of the Heartsmart™ continuous cardiac dynamic monitor in neurosurgical patients. J Neurosurg Anesthesiol 2005; 17: 156 (abstract).
Schiller NB. Pulmonary artery pressure estimation by Doppler and two-dimensional echocardiography. Cardiol Clin 1990; 8: 277-87.
Barst RJ, McGoon M and Torbicki A, et al. Diagnosis and differential assessment of pulmonary arterial hypertension. J Am Coll Cardiol 2004; 43(12_Suppl_S): 40S-47.
Parker JL, Flucker CJ and Harvey N, et al. Comparison of external jugular and central venous pressures in mechanically ventilated patient. Anaesthesia 2002; 57(6): 596-600. http://dx.doi.org/10.1046/j.1365-2044.2002.02509_4.x
Leonard AD, Allsager CM and Parker JL, et al. Comparison of central venous and external jugular venous pressures during repair of proximal femoral fracture. Br J Anaesth 2008; 101(2): 166-70. doi: 10.1093/bja/aen125. Epub 2008 May 29. http://dx.doi.org/10.1093/bja/aen125
Jansen JRC. Novel methods of invasive/non-invasive cardiac output monitoring. European Society for Intravenous Anaesthesia. http://www.eurosiva.org/Archive/Lisbon /SpeakerAbstracts/Novel%20methods%20of%20invasive.ht m.
Stetz CW, Miller RG, Kelly GE and Raffin TA. Reliability of the thermodilution method in the determination of cardiac output in clinical practice. The American Review of Respiratory Disease 1982; 126: 1001-4.
Hadian M and Pinsky MR. Evidence-based review of the use of the pulmonary artery catheter: impact data and complications. Critical Care 2006; 10(suppl 3): S8. http://dx.doi.org/10.1186/cc4834
Warring-Davies KJ. Cardiac dynamic monitoring in patients with systemic inflammatory response syndrome: A doubleblind study. Journal of Cardiovascular Disease 2013; 1(1): 41-47. ISSN: 2330-4596 (Print) / 2330-460X (Online)
Warring-Davies KJ. HeartSmart software computer program for performing haemodynamic studies at bedside during resuscitative fluid therapy: Vasopressors and inotropes. Journal for Pharmacuetical and Scientific Innovation 2013; 2(4): 20-32.
Warring-Davies KJ and Bland JM. HeartSmart™: A new method of assessing hydration in neurosurgical patients. Surgical Science 2012; 3(11): 546-553. http://dx.doi.org/10.4236/ss.2012.311108
Warring-Davies KJ and Bland JM. Validating HeartSmart® against the cardiopulmonary bypass machine. Surgical Science 2012; 3(1): 21-27. http://dx.doi.org/10.4236/ss.2012.31004
Warring-Davies K and Bland M. HeartSmart® for routine optimization of blood flow and facilitation of early goaldirected therapy. Open Access Journal of Clinical Trials 2010; 2: 115-123. http://dx.doi.org/10.2147/OAJCT.S9843
Warring-Davies KJ. The benefits of pre- and perioperative optimisation using goal directed therapy. Technic 2009: 5(7): 12-16.
Santulli G. Epidemiology of Cardiovascular Disease in the 21st Centrury: Updated numbers and updated facts. Journal of Cardiovascular Disease 2013; 1: 1. ISSN: 2326-3121 (Print) 2326-313X (Online) http://www.researchpub.org/journal/ jcvd/jcvd.html.
Warring-Davies KJ. Bedside Hemodynamic Monitoring Providing Equity of Critical and Maternity Care for the Critically Ill Pregnant or Recently Pregnant Woman. Journal of Cardiovascular Disease 2:2: 13 April 2014. ISSN: 2330- 4596 (Print) / 2330-460X (Online) http://www.researchpub.org/ journal/jcvd/jcvd.html.
Huang DT, Clermont G, Dremsizov TT and Angus DC. ProCESS Investigators. Implementation of early goaldirected therapy for severe sepsis and septic shock: a decision analysis. Crit Care Med 2007; 35(9): 2090-100. http://dx.doi.org/10.1097/01.CCM.0000281636.82971.92
Tibby SM. Murdoch IA Monitoring cardiac function in intensive care Archives of Disease in Childhood 2003; 88: 46-52. BMJ Publishing Group and Royal College of Paediatrics and Child Health27.
Warring-Davies KJ. A new simple empirical formula for calculating body surface area in children and Adults American V-King Scientific Publishing. Frontiers in Clinical Mediciene 2014; 1(2): 28-34.
